Primary Care Coding Alert

The Correct Coding Initiative (CCI) latest edits, version 9.0, offer few changes for family physicians, but coders should take note of the following:

1. G code and bladder catheterization. CCI made G0002 (Office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]) mutually exclusive with new 2003 codes 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]).

"This edit is relevant," says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. "However, it should be moot when the 2003 Medicare Fee Schedule becomes effective March 1, since CMS has deleted code G0002 for 2003. As expected, this code is going away with the addition of 51701 and 51702 to CPT."

2. Lesion excision and closure no longer separate. CCI contradicts CPT instructions by bundling 12031-12057 (Layer closure of wounds ) with 11400-11440 (Excision, benign lesion ). CPT tells coders that "For excision of benign lesions requiring more than simple closure, i.e., requiring intermediate or complex closure, report 11400-11466 in addition to appropriate intermediate (12031-12057) or complex closure (13100-13153) codes." However, the CCI edits render this CPT instruction obsolete. According to Medicare, CCI edits take precedence over any guidelines in CPT. Although private payers are not required to observe CCI edits, many do, either in whole or in part. In this case, coders should follow CCI's instructions and only code these two procedures separately with the appropriate modifier. Check with individual payers before billing.

3. CBCs. Coders can no longer bill 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and 85027 (... complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count]). Previously, CCI allowed these codes to be billed together with a modifier. "You wouldn't perform these two procedures in the same session," says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City. "But sometimes the physician will perform a CBC to determine the different types of white cells and their ratio (85025) on a sick patient and then later in the day perform a CBC to determine the total count (85027)." In such a case, only code 85025 will be paid.

4. Maternity care codes include bladder caths. CCI bundled new codes 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) with vaginal delivery codes 59400-59412. This means, Fick says, that if the physician uses a bladder catheter during delivery, the catheter insertion is included and can only be billed separately if the appropriate modifier is appended.

Codes 51701 and 51702 have also been bundled with cesarean delivery codes 59510-59515. You may use a modifier to override the bundle with 59510 and 59515; however, no modifier is allowed when coding a cesarean delivery only (59514) involving a bladder catheter (51701 or 51702). In such a case, you would only report 59514.

Delivery after a previous cesarean (59610-59622) cannot be coded separately with 51701 or 51702 unless the appropriate modifier is attached. The exceptions include 59612 and 59620, which do not allow a modifier to override the edits.